Increasing Prostate-specific Antigen Levels Research Articles

Effect of testosterone replacement therapy on lower urinary tract symptoms: A systematic review and network meta-analysis.

In this study, we aimed to perform a network meta-analysis (NMA) to investigate the effects of different testosterone replacement therapy (TRT) administration routes on lower urinary tract symptoms (LUTS) in aging men with late-onset hypogonadism (LOH). A systematic search of PubMed, Embase, The Cochrane Library, CNKI, WanFang Data, and VIP was conducted to identify randomized controlled trials (RCTs) reporting data on International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) level, or prostate volume. NMA was performed, and subgroup analysis was conducted to assess the impact of TRT duration on outcomes. A total of 21 RCTs involving 2453 participants were included. For pairwise meta-analysis, p values for TRT delivered by transdermal, intramuscular, and oral routes were as follows: IPSS: 0.93, 0.20, and 0.76; PSA level: 0.20, 0.27, and 0.98; prostate volume: 0.18, 0.04, and 0.16. There were no significant differences in IPSS, PSA level, or prostate volume between TRT routes. In subgroup analysis, long-term intramuscular TRT significantly decreased IPSS (p=0.03), short-term transdermal TRT increased PSA levels (p<0.001), and short-term intramuscular TRT increased the prostate volume (p=0.04). Other forms of TRT showed no significant change in IPSS, PSA level, and prostate volume compared with the placebo. Indirect comparison of the three administration routes demonstrated no significant differences in IPSS, PSA level, and prostate volume. Nevertheless, surface under the cumulative ranking curve analysis indicated that intramuscular TRT had an 83% probability of being the best method for decreasing IPSS. The results demonstrate that TRT does not worsen LUTS regardless of the administration route. Intramuscular TRT may be the preferred treatment for aging men with LOH and LUTS. Intramuscular TRT may be the preferred treatment for men with LOH and LUTS. Further research is warranted to validate these findings and optimize TRT management strategies.

HISTOMORPHOLOGICAL STUDY OF TRANSURETHRAL RESECTION OF PROSTATE SPECIMENS

Objectives: (The objectives of the study are as follows: 1) To study various histomorphological patterns of transurethral resection of prostate specimens. (2) To classify malignant lesions with Gleason’s grading and to do Prostate-specific antigen (PSA) level and immunohistochemistry as required. Methods: It was a cross-sectional study conducted from January 2022 to June 2023 in a tertiary care hospital. Fifty-seven patients study who underwent transurethral resection of the prostate (TURP) surgery with hypertrophied prostate during the study period were included in the study on the basis of a predefined inclusion and exclusion criteria. Demographic characteristics of all the cases were analyzed. Clinical features, presenting complaints, histopathological findings, and the final diagnosis were studied. For statistical purposes, p value &lt; 0.05 was taken as statistically significant. Results: The majority of the participants were in the age group of 60–69 years (42.11%) followed by people in the age group of 70–79 years (35.09%). Benign disease of prostrate was common than the malignant disease. BHP was the most common disease encountered and was seen in 37 (64.91%) cases. Among 37 patients with BHP, 70.27% (26) patients had increased PSA levels. Among 10 patients of BHP with CP 8 (80%) patients had increased levels of PSA. Serum PSA levels were increased in all the cases of malignancy, Adenocarcinoma prostate and PIN. Conclusion: In patients undergoing TURP modified Gleason scoring patterns and prognostic grade grouping should be done in conjunction for assessing prognosis and management. Immunohistochemistry and molecular genetic analysis are valuable adjuncts to the diagnosis in these cases.

Effect of Allium cepa (Onion) Bulb and Annona muricata (Soursop) Pulp Juices on Body Weight, Prostate Weight, Selected Hormones and Prostate-Specific Antigen (PSA) in Testosterone and Oestradiol-Induced Benign Prostatic Hyperplasia in Albino Rats

Aim: This study investigated the effect of soursop pulp and onion bulb juice samples on body weight, prostate weight (PW), percentage prostate increase inhibition (PPII), dihydrotestosterone (DHT), testosterone (T), prolactin and PSA levels in testosterone and oestradiol-induced BPH in albino rats.&#x0D; Study Design: The simple random design was used in this study.&#x0D; Place and Duration of Study: Dave Research House, Federal University of Technology, Owerri, Nigeria, between April 2022 and July 2022.&#x0D; Methodology: Fifty-four (54) male albino rats were randomly distributed into 9 groups (A-I) of 6 rats each, with B to I induced with 10 mg/kg b.w of exogenous hormones (1:1) every 2 days. They were treated as follows: A (normal control), B (BPH control), C (standard control), D (10 ml/kg b.w soursop), E (10 ml/kg b.w onion), F (10 ml/kg b.w, 1:1 soursop and onion), G (20 ml/kg b.w soursop), H (20 ml/kg b.w onion), and I (20 ml/kg b.w, 1:1 soursop and onion), for 28 days. The rats were weighed weekly. At the end of the treatment, they were euthanized, prostate and serum samples were collected for further assessments.&#x0D; Results: The results showed that at low dose, the body weights of the rats were maintained. The single samples at low dose improved PW and PPII better. DHT and T levels reduced in all test groups, and the standard control. The single samples reduced DHT levels with increase in concentration, while the soursop juice and combination samples decreased testosterone levels with increase in concentration. Prolactin levels significantly (p&lt;.05) reduced in the test groups and standard control when compared with the BPH control. While, PSA levels also decreased in the test groups, but were not significantly (p&gt;.05) different from the controls.&#x0D; Conclusion: The study suggested that soursop pulp and onion bulb juices exerted ameliorative effects on BPH, especially individually, and at the low dose studied. Hence, their consumption by older males should be encouraged.

Differentiation of patients with and without prostate cancer using urine 1 H NMR metabolomics.

Prostate cancer (PCa) is one of the most prevalent cancers in men worldwide. For its detection, serum prostate-specific antigen (PSA) screening is commonly used, despite its lack of specificity, high false positive rate, and inability to discriminate indolent from aggressive PCa. Following increases in serum PSA levels, clinicians often conduct prostate biopsies with or without advanced imaging. Nuclear magnetic resonance (NMR)-based metabolomics has proven to be promising for advancing early-detection and elucidation of disease progression, through the discovery and characterization of novel biomarkers. This retrospective study of urine-NMR samples, from prostate biopsy patients with and without PCa, identified several metabolites involved in energy metabolism, amino acid metabolism, and the hippuric acid pathway. Of note, lactate and hippurate-key metabolites involved in cellular proliferation and microbiome effects, respectively-were significantly altered, unveiling widespread metabolomic modifications associated with PCa development. These findings support urine metabolomics profiling as a promising strategy to identify new clinical biomarkers for PCa detection and diagnosis.

Prediction of Response to 177Lu-PSMA Therapy Based on Tumor-to-Kidney Ratio on Pretherapeutic PSMA PET/CT and Posttherapeutic Tumor-Dose Evaluation in mCRPC.

The aim of this study was to analyze the absorbed dose of 177Lu-PSMA in osseous versus lymphatic metastases in patients with metastatic castration-resistant prostate cancer across therapy cycles and to relate those data to therapeutic success. In addition, pretherapeutic prostate-specific membrane antigen (PSMA) PET/CT was evaluated for its ability to predict response behavior. Methods: The study comprised 30 patients with metastatic castration-resistant prostate cancer, each receiving at least 3 cycles of 177Lu-PSMA therapy. Prostate-specific antigen (PSA) values between baseline and 6 wk after the third therapy cycle were used to classify the patients as responders (PSA decline ≥ 50%) or nonresponders (unchanged or increasing PSA level). Quantitative SPECT/CT images were acquired 24, 48, and 168 h after application of 177Lu-PSMA. The absorbed dose for tumor lesions was calculated with dosimetry software. From the pretherapeutic PET/CT scan, the tumor-to-kidney uptake ratio was determined for different SUVs. Results: Regardless of patient response, the kidneys received a mean dose of 0.55 ± 0.20 Gy/GBq per cycle. In the first therapy cycle, the lymph node lesions received a mean dose of 3.73 ± 1.65 Gy/GBq in responders and 1.86 ± 1.25 Gy/GBq in nonresponders (P < 0.01). For bone lesions, the respective mean doses were 3.47 ± 2.00 Gy/GBq and 1.48 ± 0.95 Gy/GBq (P < 0.01). When successive therapy cycles were compared, the mean dose was found to have been reduced from the first to the second cycle by 27% for lymph nodes and by 33% for bone lesions. A significant difference (P < 0.01) in the ratio of lymph node and bone lesion uptake to kidney uptake between responders and nonresponders could be deduced from the pretherapeutic PET/CT scan. Conclusion: Significantly higher doses were achieved for lymph node and bone lesions in responders. The highest absorbed dose, for both lymphatic and osseous lesions, was achieved in the first cycle, decreasing in the second therapy cycle thereafter despite unchanged therapy activities. It may be possible to estimate the response to therapy from the ratio of tumor uptake to kidney uptake obtained from the pretherapeutic PSMA PET/CT scans.

The Pattern of Prostate Cancer Screening and Diagnosis among Indonesian Urologists: A Questionnaire Survey

Background: Prostate cancer (PCa) screening and diagnosis are mandatory to deliver optimal management in the early phase. Even though it has been discussed in many guidelines, the implementation of PCa screening and diagnosis in Indonesia remains unknown. This study aims to evaluate the pattern of PCa screening and diagnosis among Indonesian urologists and their adherence to guidelines. Methods: This cross-sectional study was conducted between February and July 2019. Respondents were Indonesian urologists registered as members of the Indonesian Urological Association (IUA) and had already practiced for at least six months. Data were collected using questionnaires, which were distributed at a national urology symposium and electronically via Google Form. Data were presented descriptively, and all data were processed using SPSS version 23. Results: Of 458 urologists, 195 (42.6%) gave full responses. Most of the respondents, 181 (92.8%) urologists, used the IUA guidelines. Among the 103 (52.8%) respondents who performed screening, nearly half (42.7%) agreed to screen patients aged ≥ 50 years or ≥ 45 years with a family history of PCa. Moreover, 76.8% would repeat screening annually, and 35.6% would stop when the patient’s age reached 70 years old. Digital rectal examination (DRE) was frequently performed for screening (74.5%), while prostate-specific antigen (PSA) tests were only performed in 52.3% of cases. The PSA test was available in 74.8% of hospitals. Transurethral resection of the prostate (TURP) was still used by 67.2% of respondents for diagnosis. Only 52.3 % of participants used transrectal prostate biopsy for diagnosis, using anesthesia (78.1%) during the procedure, and increased PSA level (98%) as its indication. However, Transrectal Ultrasound (TRUS) was only available in 49% of hospitals. This study found that Indonesian urologist adherence level toward guidelines was 63.3% (9–100%). Conclusions: PCa screening and diagnosis are still varied among Indonesian urologists, which might arise due to the different availability of diagnostic modalities.

Comparison of 68Ga-PSMA PET/CT and 18F-PSMA PET/CT of a Patient with Prostate Cancer Recurrence on Urinary Bladder Wall.

Prostate cancer is one of the most prevalent cancers in the world. After radical prostatectomy, prostate-specific antigen (PSA) levels are usually used as a marker of recurrence for prostate cancer. In the case of increased PSA levels, 68Ga-prostate-specific membrane antigen (PSMA) or 18F-PSMA, a new alternative, can be performed for the detection of recurrent disease. We report a case of a 49-year-old male patient with increasing PSA levels who was previously operated 8 years ago. Although no obvious pathological uptake was detected in 68Ga-PSMA positron emission tomography/computed tomography (PET/CT), 18F-PSMA PET/CT revealed a lesion with pathological uptake on the urinary bladder wall.

Prognostic role of early prostate specific antigen changes after [177 Lu]Lu-PSMA radioligand therapy of metastasized prostate cancer: A meta-analysis.

Approximately 10%-20% of prostate cancers progress to metastatic and castration-resistant forms (mCRPC). Radioligand (RLT) therapy with [177 Lu]Lu-prostate-specific membrane antigen (PSMA) is an emerging treatment for metastasized mCRPC and its efficacy is assessed not only but also by prostate specific antigen (PSA) measurement after 12 weeks or more after treatment. Our aim was to evaluate the role of early PSA measurement after RLT in predicting overall survival (OS) of mCRPC patients. A systematic search on PubMed, Web Of Science and Scopus was performed from January to December 2022. PRISMA guidelines for prognostic studies was adopted. Risk of bias was assessed using quality of prognostic studies (QUIPS). Twelve studies at low-intermediate risk of bias, were included in the meta-analysis (1646 patients, mean age 70 years). About 50% of patients showed a PSA decline after 1-2 of [177 Lu]Lu-PSMA, and more than 30% reported a PSA decline ≥50%. The median OS range for patients with any PSA decline was 13-20 months, while for patients with stable or increased PSA, the median OS fell to 6-12 months. The OS rate for a PSA decline after the one-two [177 Lu]Lu-PSMA cycles was 0.39 (95% CI: 0.31-0.50), while OS for a PSA decline ≥50% was 0.69 (95% CI: 0.57-0.83). A PSA decline is observed in almost 50% of mCRPC patients after 1-2 [177 Lu]Lu-PSMA cycles, with a significantly longer OS compared to stable or increased PSA levels, respectively. Accordingly, any PSA decline after 1-2 cycles of therapy should be regarded as a favourable prognostic factor for OS.

Diagnostic performance of 99mTc-HYNIC-PSMA SPECT/CT for biochemically recurrent prostate cancer after radical prostatectomy.

99mTc-HYNIC-PSMA is a novel technetium-99m-labeled small-molecule inhibitor of prostate-specific membrane antigen (PSMA) for detection of prostate cancer. The present study investigated the diagnostic yield of 99mTc-HYNIC-PSMA Single photon emission computed tomography (SPECT)/CT in 147 patients with biochemically recurrent prostate cancer after radical prostatectomy. 147 patients with biochemical relapse after radical prostatectomy were finally eligible for this retrospective analysis. The median prostate-specific antigen (PSA) level was 8.26 ng/mL (range, 0.22-187.40 ng/mL). Of the 147 patients, 72 patients received androgen deprivation therapy (ADT) at least 6 months before the 99mTc-HYNIC-PSMA SPECT/CT. All patients underwent planar whole-body scans and subsequent SPECT/CT of the thoracic and abdominal regions after intravenous injection of 705 ± 70 MBq of 99mTc-HYNIC-PSMA. Images were evaluated for the presence and location of PSMA-positive lesions, in which SUVmax were also measured. Detection rates were stratified according to PSA levels, ADT and Gleason scores. The relationships between SUVmax and clinical characteristics were analyzed using univariate and multivariable linear regression models for patients with positive findings. Of the 147 patients, 99mTc-HYNIC-PSMA SPECT/CT revealed at least one positive lesion in 118 patients with a high detection rate (80.3%). The detection rates were 48.6% (17/35), 85.1% (40/47), 92.1% (35/38), and 96.3% (26/27) at PSA levels of greater than 0.2 to 2, greater than 2 to 5, greater than 5 to 10, and greater than 10 ng/mL, respectively. PSMA SPECT/CT indicated local recurrence, lymph node metastases, bone metastases, and visceral metastases in 14 (9.5%), 73 (49.7%), 48 (32.7%) and 3 (2.0%) patients. The detection rates of local recurrence and metastasis increased with increasing PSA levels. The detection rate was higher in patients treated with ADT than those without (90.3% vs. 70.7%; P =0.0029). In patients with Gleason scores ≥8, detection rate was slightly higher than those with ≤7 (81.7% vs. 78.5%), but not statistically significant (P = 0.6265). Multivariable linear regression analysis showed a significant correlation of PSA levels and ADT with SUVmax (P=0.0005 and P=0.0397). 99mTc-HYNIC-PSMA SPECT/CT offers high detection rates for biochemically recurrent prostate cancer after radical prostatectomy. The detection rate and SUVmax were positively correlated with PSA levels and ADT.

Advantageous Detection of Significant Prostate Cancer Using a Low-Field, Office-Based MRI System.

Background Methods to diagnose prostate cancer (PCa), a highly prevalent disease, remain inadequate in terms of accuracy, cost, and logistical constraints for both patients and providers. Early and accurate detection of PCa is crucial to patient management, most notably in increasing quality of life and lowering cost burdens when considering the associated treatment and follow-up pathways. This article aims to discuss the impact to care pathways for nine patients whose PCa was detected by a novel Food and Drug Administration-cleared low-field magnetic resonance imager (MRI) for transperineal PCa interventions but was missed by standard-of-care systematic transrectal ultrasound (TRUS). Methodology From December 2020 to March 2022, 41 men with elevated prostate-specific antigen (PSA) levels, positive digital rectal exam findings, and Prostate Imaging Reporting & Data System scores of three or higher were enrolled.Patients first underwent targeted transperineal biopsy guided by a low-field MRI (MRIgTBx) and co-registered with T2-weighted images from a pre-procedural 3-T MRI with suspicious lesions annotated by a board-certified radiologist. Following this procedure, patients underwent standard-of-care systematic transrectal ultrasound-guided biopsy (TRUSgSBx). The entire procedure was supervised by a board-certified urologist. Results Of the 41 enrolled patients, both MRIgTBx and TRUSgSBx biopsies detected PCa in 20 patients. MRIgTBx detected PCa in an additional nine patients that were missed by TRUSgSBx. Five of the nine patients elected to pursue immediate treatment. Patients with suspected PCa and a negative biopsy return to the clinic every three to six months for PSA tests, with additional biopsies performed every year for cases with increasing PSA levels. Conclusions Early detection of PCa in nine of the 41 patients using a novel MRIgTBx method has allowed for change management resulting in an improved quality of life and cost saving for those who opted for immediate treatment. Early intervention in cases where the standard-of-care TRUSgSBx treatment was falsely negative ultimately led to a decrease in additional screening procedures, biopsies, associated tests, and an improved pathway for patient management.

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis.

This study aimed to explore the prevalence and clinical risk factors in patients diagnosed with incidental prostate cancer (IPC) during certain surgeries (transurethral resection of the prostate [TURP], open prostatectomy [OP], and holmium laser enucleation of the prostate [HoLEP]) after clinically suspected benign prostatic hyperplasia (BPH). Literature search of the MEDILINE, Web of Science, Embase, and Cochrane Library databases was performed to identify eligible studies published before June 2021. Multivariate adjusted odds ratios (ORs) and associated 95% confidence intervals (CIs) of the prevalence and clinical risk factors of IPC were calculated using random or fixed-effect models. Twenty-three studies were included in the meta-analysis. Amongst the 94.783 patients, IPC was detected in 24.715 (26.1%). Results showed that the chance of IPC detection (10%, 95% CI: 0.07-4.00; P<0.001; I2=97%) in patients treated with TURP is similar to that of patients treated with HoLEP (9%, 95% CI: 0.07-0.11; P<0.001; I2=81.4%). However, the pooled prevalence estimate of patients treated with OP was 11% (95% CI: -0.03-0.25; P=0.113; I2=99.1%) with no statistical significance. We observed increased incidence of IPC diagnosis after BPH surgery amongst patients with higher prostate-specific antigen (PSA) level (OR: 1.13, 95% CI: 1.04-1.23; P=0.004; I2=89%), whereas no effect of age (OR: 1.02, 95% CI: 0.97-1.06; P=0.48; I2=78.8%) and prostate volume (OR: 0.99, 95% CI: 0.96-1.03; P=0.686; I2=80.5%) were observed. The prevalence of IPC was similar amongst patients undergoing TURP, HoLEP, and OP for presumed BPH. Interestingly, increased PSA level was the only independent predictor of increasing risk of IPC after BPH surgery rather than age and prostate volume. Hence, future research should focus on predictors which accurately foretell the progression of prostate cancer to determine the optimal treatment for managing patients with IPC after BPH surgery.

The Effect of Ciprofloxacin on Prostate-Specific Antigen (PSA)

Increased PSA levels can be caused by prostate cancer, prostate infection, and BPH. Several studies report that the use of antibiotics can affect PSA levels. This study aims to determine the effect of ciprofloxacin administration in patients with prostate-specific antigen values ??of 4-10 ng/mL. This was an analytical study with a prospective cohort design. This study was conducted at Dr. M. Djamil Hospital, Padang starting from July 2022 until October 2022. The sampling technique used non-probability sampling with consecutive sampling method. The patient was given the antibiotic ciprofloxacin 2x500 mg for 2 weeks. PSA measurements were carried out before and after administration of antibiotics. There were 20 subject with an average age of 62.65 years (52-79). The mean of initial PSA value was 6.53 ng/mL and the final PSA value was 5.76 ng/mL. There was a significant difference between PSA levels before and after administration of ciprofloxacin (p=0.000). The use of antibiotics in patients with PSA levels of 4-10 ng/ml can reduce PSA levels.

The Prostate Gland and PSA (Prostate Specific Antigen)

Abstract The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced in the prostate, a small gland that sits below a man's bladder. PSA is mostly found in semen, which also is produced in the prostate. Small amounts of PSA ordinarily circulate in the blood. The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA levels. We use ImmunoAssay for Quantitative Measurement of PSA in Human Blood / Serum / Plasma with i-CHROMA TM Reader System with high sensitivity and specifity. We have analysed 120 patients and only 2 of them had very high value of PSA so we can determine for a prostate cancer. Additional factors increase the accuracy of PSA testing and it is not sufficient only the PSA to determine a prostate cancer so we need a rectal examination and transrectal ultrasound.

Poor Kidney Function and the risk of Prostate Cancer among Aged Men in Kogi East, Kogi State, Nigeria

Prostate Specific Antigen (PSA) is a protein that is produced by cells in the male prostate gland. An increase in PSA levels is associated with prostate inflammation, prostate cancer, and benign prostatic hypertrophy. This work provides information on the values of Kidney function indices and PSA in apparently normal ageing men residing within the Eastern zone of Kogi State, Nigeria. The subjects were divided into different groups based on their age range. There was a gradual increased in PSA and serum urea as the age increases.&#x0D; Keyword: Kidney, Prostate cancer, Prostate Specific Antigen, Blood Urea Nitrogen and Creatinine

Transrectal polyfocal biopsy under multiparametric ultrasound navigation and echocontrast in the diagnosis of prostate cancer

The main protocol for the diagnosis of prostate cancer (PC) is the determination of the level of serum prostate-specific antigen (PSA), a digital rectal examination followed by a 12-point biopsy of the PC under the guidance of transrectal ultrasonography. An isolated increase in PSA level may be the only reason for performance. However, this led to overdiagnosis and overtreatment of a clinically insignificant disease (40-65% of performed biopsies were excessive). Clinical observation. Patient, 74 years old. PSA level – 10 ng/ml (physiological and procedural factors affecting PSA level were absent). A high level of PSA gives reason to suspect the presence of pancreatic cancer. Let's note the age values of the upper level of total PSA in blood serum: 50-59 years - 3.5 ng/ml; 60-69 years old - 4.5 ng/ml; over 70 years - 6.5 ng/ml. A PSA value above 10 ng/ml is the basis for performing a biopsy of the PZ. The patient underwent a transrectal polyfocal biopsy of the prostate gland under multiparametric ultrasound guidance and Sonoview echocontrast. Pathohistological conclusion: acinar adenocarcinoma (Gleason Score 3 + 4 = 7) of the left lobe without lymphovascular and perineural invasion.

Prostate Biopsies and its Correlation with Prostate Specific Antigen in Patients Attending Birat Medical College Teaching Hospital, Morang, Nepal

INTRODUCTION: Prostate cancer is the most common malignant tumor in men over the age of 65 years. It is the second most common cause of cancer related death in men after lung cancer but it can be completely cured if detected at an early stage. Most frequently encountered diseases of the prostate are benign prostatic hyperplasia, prostatitis and carcinoma. Increased prostate specific antigen levels are found to be closely associated with prostate cancer. It is a tumour marker which is a glycoprotein and is expressed by both normal and neoplastic prostate tissue. This study was done to determine the correlation between histopathological diagnosis in prostatic biopsy and serum prostatic specific antigen level. &#x0D; MATERIALS AND METHODS: This is a hospital based cross sectional study carried out in the Department of Pathology, Birat Medical College Teaching Hospital from February 15, 2020 to October 15, 2020. A total of 84 cases were included in this study. All representative tissue sections were taken, paraffin embedded blocks were prepared and stained with hematoxylin and eosin stain. Histopathological examination was done and it’s association with serum prostatic specific antigen level was observed. &#x0D; RESULTS: In the biopsy findings, Benign Prostatic Hyperplasia (BPH) was the most common case seen in 41 (48.8%) cases out of 84 cases with maximum incidence seen in 60-69 years age group (13 cases). A total of 10 (11.9%) cases were those of prostatic adenocarcinoma and were seen in the 70-79 years age group. Majority of benign cases (BPH and BPH with prostatitis) were seen in the PSA range of 0-7ng/ml. Maximum cases of Prostatic Intraepithelial Neoplasia (PIN) were seen in the PSA range of 0-7 or 7.1-14 ng/ml and adenocarcinoma in the range of &gt;20ng/ml. The finding showed that adenocarcinoma is associated with increased level of serum PSA level. &#x0D; CONCLUSIONS: PSA is a specific marker for prostatic tissue. It can be raised in benign lesions of the prostate due to membrane disruption. However, an increased PSA level above 20 ng/ml increases the chance of detecting malignant lesions.

Correlation between Prostate Specific Antigen (PSA) Level and Various Prostatic Diseases on Biopsies: A Retrospective Study

Introduction: The prostate is a pear-shaped glandular organ that adds part of fluid to semen. The prostate consists of stromal and glandular components. Prostate needle biopsy is performed either transrectal ultrasound (TRUS) guided or transurethral routes. PSA is a glycoprotein produced by secretory cells. Normally the PSA levels are less than 4.0ng/ml.&#x0D; Aim: The main aim of the study is to find out the correlation between various pathological lesions occur in the prostate and serum Prostate Specific Antigen (PSA) level.&#x0D; Study Design: A retrospective study.&#x0D; Place and Duration of Study: Department of Pathology,Saveetha Medical college and Hospital, between January 2019 and December 2019.&#x0D; Methodology: A retrospective study of 84 prostatic biopsies for a period of 1 year in the year 2019 was carried out. All specimens subjected for histopathological examination and the relevant clinical data and Serum PSA values correlation was done.&#x0D; Results: Commonest age group being 61-70 years. Difficulty in micturition was the most common presentation .Most common lesion found was Benign Prostatic Hypertrophy(BPH) constituting 67 cases (71.42%) followed by BPH with prostatitis 17 cases (20.23%), adenocarcinoma 6 cases (7.14%) and 1 case of Prostatic Intraepithelial Neoplasia (PIN) (1.19%). BPH patients, had S.PSA levels in the range of 4.1-15 ng/ml. Three cases of adenocarcinoma showed very high levels of S.PSA (&gt;100 ng/ml) with the Gleason score of 9(5+4).&#x0D; Conclusion: Both benign and malignant pathologies can cause an increase in serum PSA levels, but the chances of finding malignancy increases with rising values of PSA. But in the management of prostatic cancer the histopathological diagnosis and grading plays a definitive role.

SIGNIFICANCE OF DETECTION OF FREE/TOTAL PSA RATIO AND OTHER BIOCHEMICAL PARAMETERS IN PATIENTS WITH BPH, CARCINOMA PROSTATE AND ITS CLINICOPATHOLOGIC CORRELATION

Background. Benign prostatic hyperplasia (BPH) can raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level does not indicate Prostate Cancer (PCa), but the higher the PSA level, the higher the chance of having PCa. Detection and treatment have been profoundly affected by the advent of Free/Total PSA ratio testing. Objectives. The aim of the study was to estimate free, total PSA levels and its ratio for serum levels of calcium, acid phosphatase and alkaline phosphatase in patients with BPH and PCa; to correlate clinical, biochemical and histopathological findings in the above patients. Methods. PSA levels were detected by Chemiluminescent assay; serum calcium – by Modified Arsenazo method; serum acid phosphatase – by Doumas et al method; and Alkaline phosphatase – by Lowry et al method. Results. Present study found high levels of total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa rate. Free/Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were considerably higher in PCa as compared to BPH. Serum calcium levels did not show significant difference in control and study groups. Conclusions. It was established that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in those without PCa. Therefore, in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary. Objectives: The study was carried out with the following objectives: to estimate free, total PSA levels and calculate Free/Total PSA ratio in patients with BPH and Carcinoma Prostate, to study the serum levels of calcium, acid phosphates, and alkaline phosphatase in patients with BPH and PCa. and to correlate clinical, biochemical and histopathological findings in the above patients. Methods. Free and total PSA levels were detected by Chemiluminescent assay; Serum Calcium was detected by Modified Arsenazo method. Serum acid phosphatase was detected by Doumas et al method and Alkaline phosphatase were detected by Lowry et al method Results: Present study found high levels of Total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa ate. Free /Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were slightly raised in PCa as compared to BPH. Serum calcium levels did not show a significant difference in control and study groups. Conclusion: We concluded that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in men without PCa. There was a negative correlation found between the free/total PSA ratio and the histopathologic findings. The lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary

A Novel Liver-targeted Testosterone Therapy for Sarcopenia in Androgen Deprived Men With Prostate Cancer.

ObjectiveAndrogen deprivation therapy (ADT) reduces muscle and bone mass, increasing frailty in men with prostate cancer. The liver mediates the whole body anabolic effects of testosterone. Based on first-pass metabolism, liver-targeted testosterone treatment (LTTT) entails oral delivery of a small dose of testosterone that does not raise peripheral blood testosterone levels. LTTT reduces blood urea and stimulates protein anabolism in hypogonadal men and postmenopausal women. We investigated whether LTTT prevents loss of lean and bone mass during ADT.MethodA 6-month, double-blind, placebo-controlled study of testosterone 40 mg/day in 50 men. Primary outcome measures were lean mass and bone mineral content (BMC). Testosterone, urea and prostate-specific antigen (PSA) were monitored. Patients were withdrawn if PSA exceeded 4 ng/mL.Results42 patients completed the study. Mean (95% CI) testosterone rose during LTTT but not placebo treatment [∆ 2.2 (1.3-3.0) vs −0.7 (−1.5 to 0.2) nmol/L; P < 0.01]. Mean PSA level did not change significantly during either treatment. Blood urea fell [∆ −0.4 (−0.9 to −0.1) mmol/L] during LTTT but not placebo [∆ 0.05 (−0.8 to 0.9) mmol/L]. BMC [∆ 49 (5 to 93) g; P < 0.02] and lean mass [∆ 0.8 (−0.1 to 1.7) kg; P = 0.04) increased compared to placebo. Five patients on LTTT withdrew from increased PSA levels, all returning to baseline levels.ConclusionLTTT shows promise as a simple therapy for preventing sarcopenia and bone loss during ADT. LTTT may induce reversible PSA rise in some patients. Further studies are required to optimize LTTT dose in ADT. LTTT has potential application in other catabolic states in men and women.

Concordance between Response Assessment Using Prostate-Specific Membrane Antigen PET and Serum Prostate-Specific Antigen Levels after Systemic Treatment in Patients with Metastatic Castration Resistant Prostate Cancer: A Systematic Review and Meta-Analysis.

Prostate-specific membrane antigen positron emission tomography (PSMA PET) has recently gained interest as a promising tool for treatment response evaluation in metastatic castration-resistant prostate cancer (CRPC). We performed a systematic review and meta-analysis assessing the concordance between response evaluation using PSMA PET and serum prostate-specific antigen (PSA) level after systemic treatment and the association between PSMA PET and overall survival in metastatic CRPC patients. PubMed, Embase, and Cochrane library databases were searched until August 2020. Studies that reported the concordance between PSMA PET and PSA response were included. PSMA PET and PSA response evaluation were dichotomized into response vs. non-response to construct two-by-two contingency tables; an ≥30% increase in PSMA PET according to PET Response Criteria in Solid Tumors 1.0 and as an increase in serum PSA level of ≥25% as per Prostate Cancer Working Group 3 guidelines were defined as non-response. The percent agreement rates were pooled using random-effect model. Ten studies (268 patients) were included. The concordance rates ranged 0.50–0.84 with a pooled proportion of 0.73 (95% confidence interval 0.67–0.79). Patients were treated with 177Lu-PSMA therapy in five, chemotherapy in three, 223Ra in one, and more than one type in one study. Various PET parameters were used: the most widely evaluated was PSMA tumor volume (PSMA-TV). Similar proportions were found across different therapeutic agents, PET response parameters, and regarding directionality of discordance (PSA response/PSMA non-response vs. PSMA response/PSA non-response). Two studies reported that a decrease in PSMA-TV was associated with better overall survival. PSMA PET and PSA response assessments were discordant in nearly a fourth of metastatic CRPC patients. Further studies are warranted to establish the clinical meaning of this discordance and define appropriate management for such clinical situation.